Healthcare Provider Details

I. General information

NPI: 1144251307
Provider Name (Legal Business Name): ADAM J. JANETTE, DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CASA ST SUITE 101
SAN LUIS OBISPO CA
93405-5803
US

IV. Provider business mailing address

77 CASA ST SUITE 101
SAN LUIS OBISPO CA
93405-5803
US

V. Phone/Fax

Practice location:
  • Phone: 805-541-5611
  • Fax: 805-541-2328
Mailing address:
  • Phone: 805-541-5611
  • Fax: 805-541-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number44324
License Number StateCA

VIII. Authorized Official

Name: DR. ADAM JOSEPH JANETTE
Title or Position: DDS/OWNER
Credential: DDS
Phone: 805-541-5611